International Journal of Epidemiology, Vol 26, 387-394, Copyright © 1997 by International Epidemiological Association
CC Johnson, BA Rybicki, G Brown, E D'Hondt, B Herpolsheimer, D Roth and CE Jackson
BACKGROUND: The prevalence of probable dementia was determined in a rural,
homogeneous community of Amish individuals in the Midwestern USA. The Amish
are a genetically isolated group with a low level of formal education (<
or = 8 years) and few exposures to modern life, who live in
intergenerational setting and have strong social support networks. METHODS:
Using community directories, trained interviewers administered the Mini
Mental State Examination (MMSE) and a medical history survey to all Amish
over 64 years old in a four county area. Individuals with scores < 27
(out of a maximum of 30 points) were given additional neuropsychological
tests. Results were reviewed by a neuropsychologist and subjects were
classified with regard to probable cognitive impairment. RESULTS: The MMSE
scores were inversely related with age and directly with education. The
Amish have higher MMSE scores than reported for the general US population.
The overall prevalence of probable cognitive impairment for those over 64
years was 6.4%. The prevalence increased with age and lower education and
was lowest among married individuals. CONCLUSIONS: The MMSE scores among
the Amish were higher than the general population despite their low level
of formal education. The lower level of cognitive impairment among the
Amish could reflect a lack of inherited susceptibility to dementing
diseases, or environmental factors characteristic of their traditional
lifestyle. Even among this population with < or = 8 years of formal
education, education may protect against cognitive impairment.
ARTICLES
Cognitive impairment in the Amish: a four county survey
Division of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, MI 48202-3450, USA.
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